Priority setting is critical to making sustainable decisions for introducing new and underutilized vaccines, in choosing among vaccine products, and in determining who gets a vaccine first when supplies are limited. In resource-constrained environments, priority setting enables complex choices that often must be made among a growing range of vaccines. Today, as every country anticipates allocation of limited supplies of a SARS-CoV-2 vaccine, the difficulty of optimizing immunization outcomes—and the need for robust priority setting—are clearer than ever.

The goal of priority setting is to drive vaccine decisions based on local knowledge of health systems, epidemiology, national capacity and financial sustainability. Establishing a local context is crucial to making tractable, useful, evidence-informed decisions.

The web-based decision-support tool, SMART Vaccines 2.0, based on Multi-Criteria Decision Analysis methodology, was designed to elicit the subjective and competing aspects of vaccine decision making, and to combine those with both quantitative and qualitative evidence. This tool was implemented in a pilot project by the Uganda National Immunisation Technical Advisory Group (NITAG), the results of which were recently published in BMJ Global Health.

The Ugandan Ministry of Health had requested the NITAG to develop recommendations on the prioritized introduction of five new vaccines. McCormick and coauthors report on the NITAG’s use of SMART Vaccines 2.0, in parallel to existing decision-making processes, as they produced recommendations that were accepted in full. They found that SMART Vaccines 2.0 revealed committee preferences and biases that influenced recommendations, an important test of their sensitivity.

Feedback from this pilot informed further evolution of the tool to meet the needs of decision makers, resulting in its next-generation version, PriorityVax. This improved platform, supported by the Sabin Vaccine Institute, has a more streamlined user experience and a clearer selection and use of attributes. Users can easily tailor PriorityVax to incorporate local evidence-to-recommendation processes.

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